Name: 3d planning and printing of patient specific implants for reconstruction of bony defects
Uploaded: 2020-08-04T13:00:00
Description: Watch this Scientific Journal Video about 3D Planning and Printing of Patient Specific Implants for Reconstruction of Bony Defects at JoVE.com

No funding was received for this work.

This study followed the Declaration of Helsinki on medical protocol and ethics and the Institutional Ethical Review Board approved the study.
1. Segmentation using a segmentation software
NOTE: The import process of the DICOM files requires the orientation of the axial, coronal and sagittal planes in the pop-up window to finish the setup.
<ol>
	<li>In the Bone Segmentation menu, choose the General feature. Use the marker &#34;<str...

<ol>
	<li>Goodsaid, F., Frueh, F., Burczynski, M. E., Hock, F., Gralinski, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Personalized+Medicine.">Personalized Medicine.</a> Drug Discovery and Evaluation: Methods in Clinical Pharmacology. , (2019).</li><li>Hull, C. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Apparatus+for+production+of+three-dimensional+objects+by+stereolithography.">Apparatus for production of three-dimensional objects by stereolithography.</a> Google Patents. , (1986).</li><li>Petzold, R., Zeilhofer, H. F., Kalender, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid+prototyping+technology+in+medicine--basics+and+applications.">Rapid prototyping technology in medicine--basics and applications.</a> Computerized Medical Imaging and Graphics. 23 (5), 277-284 (1999).</li><li>Schmauss, D., Gerber, N., Sodian, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+printing+of+models+for+surgical+planning+in+patients+with+primary+cardiac+tumors.">Three-dimensional printing of models for surgical planning in patients with primary cardiac tumors.</a> The Journal of Thoracic and Cardiovascular Surgery. 145 (5), 1407-1408 (2013).</li><li>Tam, M. D., Laycock, S. D., Bell, D., Chojnowski, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=3-D+printout+of+a+DICOM+file+to+aid+surgical+planning+in+a+6+year+old+patient+with+a+large+scapular+osteochondroma+complicating+congenital+diaphyseal+aclasia.">3-D printout of a DICOM file to aid surgical planning in a 6 year old patient with a large scapular osteochondroma complicating congenital diaphyseal aclasia.</a> Journal of Radiology Case Reports. 6 (1), 31 (2012).</li><li>Emodi, O., Shilo, D., Israel, Y., Rachmiel, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+planning+and+printing+of+guides+and+templates+for+reconstruction+of+the+mandibular+ramus+and+condyle+using+autogenous+costochondral+grafts.">Three-dimensional planning and printing of guides and templates for reconstruction of the mandibular ramus and condyle using autogenous costochondral grafts.</a> British Journal of Oral and Maxillofacial Surgery. 55 (1), 102-104 (2017).</li><li>Leiser, Y., Shilo, D., Wolff, A., Rachmiel, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+reconstruction+in+mandibular+avulsion+injuries.">Functional reconstruction in mandibular avulsion injuries.</a> Journal of Craniofacial Surgery. 27 (8), 2113-2116 (2016).</li><li>Mazzoni, S., Bianchi, A., Schiariti, G., Badiali, G., Marchetti, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-aided+design+and+computer-aided+manufacturing+cutting+guides+and+customized+titanium+plates+are+useful+in+upper+maxilla+waferless+repositioning.">Computer-aided design and computer-aided manufacturing cutting guides and customized titanium plates are useful in upper maxilla waferless repositioning.</a> Journal of Oral and Maxillofacial Surgery. 73 (4), 701-707 (2015).</li><li>Rachmiel, A., Shilo, D., Blanc, O., Emodi, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+of+complex+mandibular+defects+using+integrated+dental+custom-made+titanium+implants.">Reconstruction of complex mandibular defects using integrated dental custom-made titanium implants.</a> British Journal of Oral and Maxillofacial Surgery. 55 (4), 425-427 (2017).</li><li>Xu, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+of+the+upper+cervical+spine+using+a+personalized+3D-printed+vertebral+body+in+an+adolescent+with+Ewing+sarcoma.">Reconstruction of the upper cervical spine using a personalized 3D-printed vertebral body in an adolescent with Ewing sarcoma.</a> Spine. 41 (1), E50-E54 (2016).</li></ol>

With the constant developing use of computers for virtual planning of surgical procedures, the combination with another developing technology, 3D printing, led to a whole new era of surgical treatment. Accuracy is the goal of these technologies and patient specific care, as the future goal, is presented in the form of surgical guides and patient specific reconstruction implants. We discuss surgical guides as part of a different future protocol. In the current protocol, we discuss the segmentation of DICOM images into 3D ...

Personalized medicine is developing rapidly in many fields of medicine1. Oncologic personalized treatment is a subject of much discussion and thus is well known to the general population. 3D printing was first introduced by Charles Hull showing 3D printing of objects using stereolithography2. Since then, different technologies for 3D printing were developed. The method used is selected based on the purpose of the device.
The surgical field is rapidly embracing personalized medicine. Personalized treatment in the surgical field requires virtual planning using a computer-assisted design (CAD) software. The first stage always includes segmentation to create a 3D stl file. Computer assisted manufacturing (CAM) is referred as the manufacturing process of the 3D designed part. The first utilization of the technology was used in pre-operative model printing for surgical planning and mock surgery3,4,5. With the development of technology, virtual planning of the surgeries followed by the planning and manufacturing of surgical guides to assist in the surgery itself and patient specific reconstruction implants fitted perfectly on the bone of the patient became more popular6,7,8,9,10. The purpose of this protocol is to provide clinicians with the ability to create their own surgical guides and reconstruction patient specific implants. This method is more accurate than using stock plates because it fits perfectly and can be designed based on the characteristics of the specific defect. It also reduces the dependency on the surgeon&#39;s experience and reduces operation time.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>D2P (DICOM to Print)</td>
			<td>3D systems</td>
			<td></td>
			<td>Segmentation software to create 3D stl files</td>
		</tr>
		<tr>
			<td>Geomagic Freeform</td>
			<td>3D systems</td>
			<td></td>
			<td>Sculpted Engineering Design</td>
		</tr>
	</tbody>
</table>

3d planning and printing of patient specific implants for reconstruction of bony defects

We are in the midst of the 3D era in most aspects of life, and especially in medicine. The surgical discipline is one of the major players in the medical field using the constantly developing 3D planning and printing capabilities. Computer-assisted design (CAD) and computer assisted manufacturing (CAM) are used to describe the 3D planning and manufacturing of the product. The planning and manufacturing of 3D surgical guides and reconstruction implants is performed almost exclusively by engineers. As technology advances and software interfaces become more user-friendly, it raises a question regarding the possibility of transferring the planning and manufacturing to the clinician. The reasons for such a shift are clear: the surgeon has the idea of what he wants to design, and he also knows what is feasible and could be used in the operating room. It allows him to be prepared for any scenario/unexpected results during the operation and allows the surgeon to be creative and express his new ideas using the CAD software. The purpose of this method is to provide clinicians with the ability to create their own surgical guides and reconstruction implants. In this manuscript, a detailed protocol will provide a simple method for segmentation using segmentation software and implant planning using a 3D design software. Following the segmentation and stl file production using segmentation software, the clinician could create a simple patient specific reconstruction plate or a more complex plate with a cradle for bone graft positioning. Surgical guides can be created for accurate resection, hole preparation for proper reconstruction plate positioning or for bone graft harvesting and re-contouring. A case of lower jaw reconstruction following plate fracture and nonunion healing of a trauma sustained injury is detailed.

A 40 year old female patient with a broken, stock supplied, reconstruction fixation plate from a previous injury and a non-union fracture in the left body of her lower jaw presented to the department. Imaging shows the broken fixation plate and the mal-positioned left segment of the lower jaw (Figure 1). Using segmentation software, segmentation of the lower jaw was performed separating the broken fixation plate (Supplemental Figure 1 and <st...

Watch this Scientific Journal Video about 3D Planning and Printing of Patient Specific Implants for Reconstruction of Bony Defects at JoVE.com

3D Planning and Printing of Patient Specific Implants for Reconstruction of Bony Defects

This protocol describes the use of 3D planning and printing for reconstruction of bony defects. We use segmentation tools to create 3D models followed by 3D design software to create patient specific implants for reconstruction purposes concomitant to ablative surgery or as a second stage.

We are in the midst of the 3D era in most aspects of life, and especially in medicine. The surgical discipline is one of the major players in the medical ...

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